New valproate regulations, informed choice and seizure risk.

Valproate is the most effective medication for generalised epilepsies, and several specific epilepsy syndromes. For some people, it will be the only medication to establish seizure remission, and withdrawing it carries risks of seizure recurrence and Sudden Unexpected Death in Epilepsy (SUDEP). It is also of proven efficacy for bipolar disorder and migraine prevention.

New-onset seizures in older people: Clinical features, course and outcomes.

Objective: The incidence of epilepsy increases with age. With current demographic trends, this presents a healthcare challenge. We investigated the clinical spectrum of first seizures, evaluated neuroimaging and EEG findings, and determined clinical outcomes, including anti-seizure medication (ASM) response in older people.

Epilepsy & gambling: Risk factors for problem gambling behaviors in people with epilepsy.

Objective: Problem gambling results from the complex interaction of neurological factors with psychological, demographic, and socioeconomical influences. The vulnerabilities of people with epilepsy to many of these influences may increase their susceptibility to developing problematic gambling behaviors. The aim of this study was to establish the frequency of gambling participation and the clinical correlates of problem gambling behaviors in people with epilepsy.

Memory complaints in the epilepsy clinic.

Cognitive complaints in people with epilepsy are usually multifactorial in their nature and origin. While antiepileptic medications are an important consideration, we explore other ways in which neurologists can address cognitive problems in this population. It is never too early to ask about cognitive impairment, and the answers can have diagnostic significance.

Neuropsychological outcomes following traumatic brain injury.

This review examines the clinical and neuroradiological features of traumatic brain injury that are most frequently associated with persistent cognitive complaints. Neuropsychological outcomes do not depend solely on brain injury severity but result from a complex interplay between premorbid factors, the extent and nature of the underlying structural damage, the person's neuropsychological reserve and the impact of non-neurological factors in the recovery process. Brain injury severity is only one of these factors and has limited prognostic significance with respect to neuropsychological outcome.

The role of obesity in cognitive dysfunction in people with epilepsy.

Objective: In the general population, obesity is associated with accelerated age-related cognitive decline. The impact of obesity on cognitive function in neurological populations who already have a heightened risk of cognitive decline is unknown. This study explored the relationship between obesity and cognitive underfunction in people with medically intractable epilepsy.

Bright light therapy for symptoms of anxiety and depression in focal epilepsy: randomised controlled trial.

Background: Bright light therapy is an effective treatment for seasonal affective disorder and non-seasonal depression. Depression and anxiety are common psychiatric comorbidities in epilepsy.

Aims: To examine the efficacy of bright light therapy for symptoms of anxiety and depression in adults with focal epilepsy (trial registration at ClinicalTrials.

Bright light therapy as an add on treatment for medically intractable epilepsy.

Background: Bright light therapy (BLT) influences the regulation of melatonin and is an established treatment for seasonal affective disorder (SAD). This study was designed to examine the efficacy of BLT for seizure control in adults with focal epilepsy.

Design: 101 adults with medically intractable focal epilepsy were recruited to a parallel-design, double-blind, randomized trial of BLT as an add on treatment for epilepsy.

Socioeconomic status, cognition, and hippocampal sclerosis.

Objective: Poorer surgical outcomes in patients with low socioeconomic status have previously been reported, but the mechanisms underlying this pattern are unknown. Lower socioeconomic status may be a proxy marker for the limited economic opportunities associated with compromised cognitive function. The aim of this study was to examine the preoperative neuropsychological characteristics of patients with unilateral hippocampal sclerosis (HS) and their relationship to socioeconomic status.

Cognitive consequences of childhood-onset temporal lobe epilepsy across the adult lifespan.

Objectives: To examine the influence of side of pathology and gender on changes in cognitive function across the adult lifespan in a homogenous sample of patients with mesial temporal lobe epilepsy (MTLE) associated with unilateral hippocampal sclerosis (HS).

Methods: We retrospectively examined the neuropsychological profiles of 382 patients in 3 cohorts: cohort 1 aged 18-30 (n = 171), cohort 2 aged 31-45 (n = 170), and cohort 3 aged 46-65 (n = 41). All participants had medically intractable seizures associated with unilateral HS and an onset of epilepsy in childhood, with an average onset at 7 years.

The long-term retention of pregabalin in a large cohort of patients with epilepsy at a tertiary referral centre.

Pregabalin (PGB) is a new antiepileptic drug (AED) which is a structural, non-functional analogue of gamma-aminobutyric acid. It acts at presynaptic calcium channels to modulate neurotransmitter release in the CNS. While the efficacy and tolerability of PGB have been demonstrated in several randomised controlled trials, few studies have addressed long-term outcome in large groups of patients.

First report of Creutzfeldt-Jakob disease occurring in 2 siblings unexplained by PRNP mutation.

Sibling concurrence of pathologically confirmed prion disease has only been reported in association with pathogenic mutation of the prion protein gene (PRNP). Here, we report 2 siblings with classic neuropathologic features of sporadic Creutzfeldt-Jakob disease unexplained by PRNP mutation or known risk factors for iatrogenic transmission of prion infection. Possible explanations include coincidental occurrence, common exposure to an unidentified environmental source of prions, horizontal transmission of disease, or the presence of unknown shared genetic predisposition.

The socioeconomic, cultural, and emotional implications of starting or withholding treatment in a patient with a first seizure.

The decision to treat or not treat individuals who have suffered a single epileptic seizure is based on clinical factors, which are considered within the individual's social, cultural, and emotional environment. Even if optimally communicated, individuals and their carers will make different decisions about first seizures and their treatment, as they will judge the risks and benefits of treatment (or its deferment) in this wider context. There is a significant body of literature that describes the impact of established epilepsy on aspects of an individual's overall quality of life (QoL), and more recently evidence is emerging about the factors that may be important in 2 years after a single seizure on and off treatment.

Antiepileptic drugs: generic versus branded treatments.

Antiepileptic drugs (AEDs) are relatively cheap but high volumes of prescriptions mean that substantial drug-budget savings may be possible by switching from innovator brands to cheaper generic drugs. Such savings have been achieved in many other treatment areas. However, more caution may be needed in the case of epilepsy because of the narrow therapeutic range of most AEDs; clinical principles of prescribing, which include making only cautious and gradual changes to dosing; the health and socioeconomic impact of breakthrough seizures or toxicity; and the need for long-term consistency of supply.

Home versus outpatient administration of intravenous steroids for multiple-sclerosis relapses: a randomised controlled trial.

Background: Intravenous steroids are routinely used to treat disabling relapses in multiple sclerosis, and can be administered in an outpatient or home setting. We developed a rating scale that allowed us to compare the two strategies formally in a trial setting.

Methods: Patients who had a clinically significant multiple-sclerosis relapse within 4 weeks of onset were randomly assigned administration of a 3-day regimen of intravenous methylprednisolone either in an outpatient clinic (n=69) or at home (n=69).

Cost-effectiveness of carbamazepine in epilepsy.

Carbamazepine is widely recommended as a first-line antiepileptic drug for new-onset partial seizures with or without generalization. Branded carbamazepine remains commonly prescribed. Newer antiepileptic drugs have higher acquisition costs than carbamazepine, but may offer advantages in terms of tolerability and side-effect profile that may offset their additional cost.

Emerging therapies in multiple sclerosis.

Multiple sclerosis (MS) is the most common neurological cause of disability in young people. The disease-modifying treatments, IFN-beta and glatiramer acetate, have been widely available over the last decade and have shown a beneficial effect on relapse rate and magnetic resonance imaging parameters of disease activity; however, their effect on disease progression and disability is modest. Therefore, the search for alternative treatment strategies continues.

Sarcoid polyneuropathy responsive to intravenous immunoglobulin.

We describe a 38-year-old woman with a predominantly sensory axonal polyneuropathy in whom a nerve biopsy demonstrated sarcoid granulomas. The neuropathy did not respond to oral steroid therapy but there was a rapid and repeated response to intravenous immunoglobulin, which gradually diminished over subsequent treatments, but remained beneficial. The systemic sarcoidosis remained active.

Socioeconomic variation in incidence of epilepsy: prospective community based study in south east England.

Objective: To determine the incidence of epilepsy in a general practice population and its variation with socioeconomic deprivation.

Design: Prospective surveillance for new cases over an 18 or 24 month period.

Participants: All patients on practice registers categorised for deprivation with the Carstairs score of their postcode.